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Logo of aicSpringerOpen.comThis journalSubmit a manuscriptRegisterSpringerOpen.comAnnals of Intensive Care
 
Ann Intensive Care. 2012; 2: 4.
Published online Feb 17, 2012. doi:  10.1186/2110-5820-2-4
PMCID: PMC3310851
A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death
Ari R Joffe,corresponding author1,2 Natalie R Anton,1 Jonathan P Duff,1 and Allan deCaen1
1Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
2The John Dossetor Health Ethics Center, University of Alberta, Edmonton, Alberta, Canada
corresponding authorCorresponding author.
Ari R Joffe: ari.joffe/at/albertahealthservices.ca; Natalie R Anton: Natalie.anton/at/albertahealthservices.ca; Jonathan P Duff: Jon.duff/at/albertahealthservices.ca; Allan deCaen: allan.decaen/at/albertahealthservices.ca
Received August 5, 2011; Accepted February 17, 2012.
Abstract
Background
Neurologists often diagnose brain death (BD) and explain BD to families in the intensive care unit. This study was designed to determine whether neurologists agree with the standard concept of death (irreversible loss of integrative unity of the organism) and understand the state of the brain when BD is diagnosed.
Methods
A previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States. Main outcomes were: responses indicating the concept of death that BD fulfills and the empirical state of the brain that would rule out BD.
Results
After the second mailing, 218 (44%) surveys were returned. Few (n = 52, 27%; 95% confidence interval (CI), 21%, 34%) responded that BD is death because the organism has lost integrative unity. The most common justification was a higher brain concept (n = 93, 48%; 95% CI, 41%, 55%), suggesting that irreversible loss of consciousness is death. Contrary to the recent President's Council on Bioethics, few (n = 22, 12%; 95% CI, 8%, 17%) responded that the irreversible lack of vital work of an organism is a concept of death that the BD criterion may satisfy. Many responded that certain brain functions remaining are not compatible with a diagnosis of BD, including EEG activity, evoked potential activity, and hypothalamic neuroendocrine function. Many also responded that brain blood flow and lack of brainstem destruction are not compatible with a diagnosis of BD.
Conclusions
American neurologists do not have a consistent rationale for accepting BD as death, nor a clear understanding of diagnostic tests for BD.
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